August 6, 2017

I started practicing dentistry in 1973…that’s 44 years ago. A lot has happened in those years. We went from the predominance of amalgam to chiefly metal free restorations. From bridgework to implants. I saw the advent of new materials, new equipment and all kinds of new technology.

Some of it, like veneers and implants, and digital radiographs changed dentistry. Other advances are now obsolete like air abrasion for cavity preparation. And some had questionable benefits, like computerized local anesthesia.

No matter how long you have been in dentistry I am sure you have seen many trends and fads come and go. That is why the best dentistry is principle centered dentistry.

I recently read a post on Facebook by an older very prominent dentist who confessed that as he got older he was becoming frustrated when he saw some of his work failing. He blamed it on patient’s non-compliance I sympathized with him. I too have gotten older and see the same phenomenon.

Years ago I bought into the idea of doing “predictable” dentistry – or dentistry that lasts. I came to realize through some pretty good mentors that the only way to get there was to do comprehensive relationship based dentistry. I was so taken by that concept that I wrote my first book,The Art of the Examinationwhich spelled out the entire system. It’s that philosophy that attempts to create dentistry that lasts – not any trend or fad such as digital radiographs or lasers.

Younger dentists these days are enamored with the latest technology. The newer practices promote the latest fads and technologies rather than focus on great diagnosis, treatment planning and creating strong high quality relationships.

I came of age in dentistry when perennialism ruled. In other words we were taught everlasting principles that could create success through many generations. Preventative dentistry for example is a perennial philosophy. For those who have been around, I think you understand what I mean by some of the changes we see.

Less and less people see the dentist regularly. More and more full mouth implant cases are being done these days. Sure–a lot has happened culturally, politically and economically, but I still believe that comprehensive relationship based dentistry holds the answers to this cultural mismatch.

Comprehensive relationship based dentistry that is based on human universals which are features of a culture, society, behaviors, and psyche that stay consistent through time and place. These include leadership, trust, empathy and storytelling among many others.

We tend to throw the term comprehensive relationship based dentistryaround as if it has lost its meaning. If we want to do our jobs properly with a sense of duty then we must do this type of dentistry.

Comprehensive means complete. If we do complete dentistry it starts with a complete exam in order to uncover every single etiologic factor of disease. Everyone knows that…it’s the practicing that makes it difficult. I am sure the dentist I mentioned above practices comprehensively.

It’s the second part—the relationship-based part where things get sticky. This is the part, I believe, that dentists truly have let go. Fully understanding and taking the time to create and maintain strong relationships is less common today than ever before. The cultural mismatch.

If the dentist is experiencing frustration because his or her work is failing because of non-compliance, then this can’t get fixed with more technical advances. These are relationship issues. These are leadership and communication issues. That is why it is impossible to do comprehensive dentistry with the human factor.

Dentistry is changing. The profession needs to step up from within. I see major gaps in thinking between the older generation of dentists and the younger dentists just starting out. There has been a paradigm shift. Blog posts and social media groups are questioning the future of dentistry.

Please weigh in with your feelings – what have you experienced and what do you see happening as we go into the future?

1 Comment

Wow, thanks for such an open and honest article. I agree with a lot of what you said. The thing is, times change and people come and go.
On that last part about people. It seems to me that folks just move more often than when I first started my practice. I don’t know why. But it seems to me the length of time that I had a recurring patient. One that I’d get to know and see grow up, has dramatically decreased. And I don’t have the same deep relationships with newer patients.